The Diet and Age-related Macular Degeneration: the foods we should be eating to protect our eyes
Author: Mr. Miguel Gedtal, PhD Researcher
Centre for Public Health
Queen’s University Belfast
Age-related macular degeneration (AMD) is a disease that can lead to blindness. With age, the retina (the tissue in the eye where light is detected) collects debris, but in AMD, the amount of debris increase in size and number; this causes areas of the tissue to die and abnormal blood vessels to grow1. What we eat could protect our eyes from AMD.
Studies have found that people who closely follow the Mediterranean diet (MeDi) are less likely to progress to worse stages of AMD, compared to those who don’t follow the diet2, 3. There are variations to the MeDi but the common components are frequent intake of fish and plant foods (including fruits and veg); moderate alcohol intake; and infrequent intake of red meat. Another study suggests a diet where fish, fruit and veg are frequently eaten could lower the risk of having AMD4, 5.
Fruits and veg are rich in anti-oxidants that protect the eye from damage6. Specifically, anti-oxidants called lutein and zeaxanthin (L+Z) can collect in the retina as a substance called macular pigment: eating green leafy veg kale and spinach, both foods high in L+Z, have been observed to increase macular pigment7, 8. Studies report that frequent fruit or veg intake could slow disease progression, but not its prevention2, 4, 9. The same results were found even when only the fruits and veg rich in L+Z, like spinach and other green leafy veg, were considered alone4, 9. A daily supplement containing a combination of L+Z, minerals and vitamins has been proven to slow AMD progression; in some countries like UK, they are prescribed by clinicians to AMD patients10-12. Furthermore, current UK guidelines advise those with confirmed AMD to eat a healthy diet rich in fruits, green leafy veg and fish11, 13.
Consumption of fish can protect against AMD, partly due to omega-3 fat content2, 4. Fish are rich in omega-3 fats that defend the retina from damage and abnormal blood vessel growth14, 15. Although omega-3 is available in supplements, when consumed this way, rather than in food, omega-3 fats neither prevented nor slowed disease progression, indicating that their presence in foods may have better effects16, 17.
A major risk factor for AMD is genetic background. A large European study reported that those at high risk of late-stage AMD owing to genetic background could reduce their risk by both not smoking and frequently eating fish, fruits and veg5. Furthermore, studies have shown a person’s genetic background could alter the impact of diet on AMD in complex ways. For example, specific genetic changes could interfere with the protective effect of fish intake from AMD progression2.
Overall, there is evidence from recent studies to promote a diet rich in fruit, veg including spinach and kale, and fish for slowing the progression of AMD. Future research should investigate the interactions of this diet, other lifestyle choices (e.g., smoking, exercise) and genetics to maximise the benefits of this diet and to confirm whether it could prevent AMD.
Discover our simple ways to include more lutein rich greens
Kale, spinach and cavolo nero are easy to use and very versatile – to increase your consumption of these lutein rich brassicas why not try one of our top tips:
- Add a to your bolognese (veggie or traditional)
- Stir into a veggie soup for extra colour, flavour, texture and lutein!
- Mix into mashed potato for a delicious Champ. Perfect for topping savoury pies or serve with sausages
- Stir fry with other veg for a colourful and lutein rich simple supper
- Pairing well with both garlic and chilli, they make a great addition to both pasta and curries
References:
1. Handa JT, Bowes Rickman C, Dick AD, Gorin MB, Miller JW, Toth CA, et al. A systems biology approach towards understanding and treating non-neovascular age-related macular degeneration. Nature Communications. 2019;10(1):3347.
2. Keenan TD, Agrón E, Mares J, Clemons TE, van Asten F, Swaroop A, et al. Adherence to the Mediterranean Diet and Progression to Late Age-Related Macular Degeneration in the Age-Related Eye Disease Studies 1 and 2. Ophthalmology. 2020;127(11):1515-28.
3. Merle BMJ, Colijn JM, Cougnard-Grégoire A, de Koning-Backus APM, Delyfer M-N, Kiefte-de Jong JC, et al. Mediterranean Diet and Incidence of Advanced Age-Related Macular Degeneration: The EYE-RISK Consortium. Ophthalmology. 2019;126(3):381-90.
4. de Koning-Backus APM, Buitendijk GHS, Kiefte-de Jong JC, Colijn JM, Hofman A, Vingerling JR, et al. Intake of Vegetables, Fruit, and Fish is Beneficial for Age-Related Macular Degeneration. American Journal of Ophthalmology. 2019;198:70-9.
5. Colijn JM, Meester-Smoor M, Verzijden T, De Breuk A, Silva R, Merle BMJ, et al. Genetic Risk, Lifestyle, and Age-Related Macular Degeneration in Europe. Ophthalmology. 2021;128(7):1039-49.
6. Banerjee M, Chawla R, Kumar A. Antioxidant supplements in age-related macular degeneration: are they actually beneficial? Therapeutic Advances in Ophthalmology. 2021;13:25158414211030418.
7. Arnold C, Jentsch S, Dawczynski J, Bohm V. Age-related macular degeneration: Effects of a short-term intervention with an oleaginous kale extract-a pilot study. Nutrition. 2013;29(11-12):1412-7.
8. Ozawa Y, Nagai N, Suzuki M, Kurihara T, Shinoda H, Watanabe M, et al. [Effects of Constant Intake of Lutein-rich Spinach on Macular Pigment Optical Density: a Pilot Study]. Nippon Ganka Gakkai Zasshi. 2016;120(1):41-8.
9. Wu J, Cho E, Willett WC, Sastry SM, Schaumberg DA. Intakes of Lutein, Zeaxanthin, and Other Carotenoids and Age-Related Macular Degeneration During 2 Decades of Prospective Follow-up. JAMA Ophthalmology. 2015;133(12):1415-24.
10. The Age-Related Eye Disease Study 2 Research Group. Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial. JAMA. 2013;309(19):2005-15.
11. Clinical Knowledge Summaries National Institute for Health and Care Excellence. Scenario: Confirmed age-related macular degeneration 2020 [Available from: https://cks.nice.org.uk/topics/macular-degeneration-age-related/management/confirmed-amd/.
12. Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, et al. Age-Related Macular Degeneration Preferred Practice Pattern®. Ophthalmology. 2020;127(1):P1-p65.